UC11: Health Center Worker assesses for high risk conditions during pregnancy and
refers to district hospital for treatment
Description: There are a host of conditions that place a mother at higher risk for
morbidity/mortality during her pregnancy. Some of these are of an acuity that
would encourage the mother’s triage to a district hospital for more tertiary care
services. Some conditions, however, such as early anemia, can be supported
through counseling and behavioral modification suggestions. This use case
describes work flows and behaviors consistent with referral of high risk issues
to a district hospital secondary to a scheduled or out of cycle antenatal visit…
Actors: Community Health Worker, Health Center Worker, Patient, patient
record system (OpenMRS), District Health Worker, and Shared Health Record
(SHR)
Pre-Conditions: Mother has been checked into the health center, and has been
identified during the visit as having a high-risk health care condition.
Post-Conditions:
Special Requirements:
Event Flow Chart:
Ideal Pathway: While entering the clinical encounter into OpenMRS, health
center worker notes a high risk condition which requires referral, appropriate
contextual information about immediate treatment suggestions for that
condition are generated and pushed to health center worker (clinical
reminders/guidance, referral instructions), patient is registered in SHR as
having this high-risk condition, for others to be aware of. SMS alert sent to CHW
of this high-risk condition. “Alert” (not clear of the technology available in a
district hospital?) sent to district hospital about impending high-risk visit.
Technology Navigation:
State Diagrams (if applicable):
Alternative Pathway(s):

Contextual information not available to clinician in real time: While
entering the clinical encounter into OpenMRS, patient is registered in SHR
as having this high-risk condition, for others to be aware of. SMS alert
sent to CHW of this high-risk condition. Alert also sent to district health
center.


Data Entry Clerk vs. Nurse/Midwive direct entry: real-time alerts
could not be generated in this case either, given that forms are typically
entered following the encounter, which is too late.
No patient manangement system at district hospital: unclear how
alerts could be sent to district hospital about pending transfer in this
case. Need more information about technology in district hospital.
Extension Points (other use cases that link):